Plaque order form

1. Complete form

2. Send payment

progress bar which indicats 1 step in ordering plaque

How to order your plaque online

Step 1: Complete and submit the form on this page. You will receive an email as a record of what details you gave us.
Step 2: Send payment separately (by credit card or BACS transfer).

Step 1: Complete form

Required fields are marked with *

Company details:

Please write down the name of the organisation as it should appear on the glass panel of your plaque. This should be checked and agreed by all the relevant people in your organisation before you send the form in. You will not receive a proof, so please ensure these details are correct.

* Organisation name to appear on your plaque

* I confirm that the wording above is correct and should appear on the plaque. Note: Paul Hodgkiss Designs and SCHWL will not be held responsible where organisations do not supply the correct wording for their plaques.

Contact/delivery details:

* Contact name

* Address

* Telephone

* Email

Health Working Lives adviser details:

Please insert your Healthy Working Lives adviser's details.

* Name of HWL adviser

* HWL adviser telephone

Plaque details:

Please choose your plaque level.

* Plaque level (please tick)

Gold
Silver
Bronze
Mental Health Commendation

Any special instructions

Payment details:

Please select the number of plaques. Each plaque costs £225.82 (VAT and delivery charge inclusive).

Item

Price

Quantity

Sub total

Plaque

£225.82

£0.00

Total

£0.00

Section navigation: